Association of Diabetes Care & Education Specialists

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What should our nutritional messages look like?

Feb 11, 2011

I recently received a phone call from a well-respected colleague. The voiced concern was regarding a poster advertising a pool and pizza party for children with diabetes. The caller wondered what I thought of the idea of advertising this in a small community, inferring that pizza was a good food.

I must admit, I was a bit taken back. As I tried to form a response, my thoughts included: Is pizza really a bad food? Should people with diabetes avoid it? Is a pizza party for kids with type 1 diabetes a bad idea? What should we be offering instead?

As my mind raced over my response, I realized I had to answer in the way I tend to approach diabetes and all chronic disease. It is not about bad food, it is about moderation. There are SO MANY food restrictions reported nationwide: carbohydrates are bad, minimize foods rich in saturated fat and avoid all those with trans-fats (even legislation to eliminate them). There are arguments about buying local, organic and dark vs. light vegetables. There are recommendations to avoid sugar substitutes as well as food with high fructose corn syrup. And of course, there is the importance (and necessary requirement) for individuals with type 1 diabetes to count carbohydrates methodically. So back to the question, should we, as diabetes educators, offer pool and pizza parties to kids with diabetes? Does it infer a poor example for others struggling with diabetes?

So, my answer included the following:

Number one--and the most important aspect of the event--is getting children together that have diabetes. Allowing children with type 1 diabetes to play, have fun, and see others kids that have the same day-to-day frustrations of not knowing if they are having going to have a day filled with high or low blood sugars.

Number two--the party is focused on physical activity, a pool party. Encouraging children to exercise, and role modeling the possibilities of being active with diabetes is excellent.

Number three--pizza is not a bad food; moderation in all things, including pizza. The organizers may be offering pizza with whole grain crust, loaded with vegetables, and/or moderate in meat. There may be vegetable sticks to snack on, and bottled water for drinking with it. I jokingly said that I would, however, be concerned if they were offering beer and chips.

So overall, I hope we, as diabetes educators, are focused on encouraging moderation in foods that are less healthy, and encouraging exercise on a regular basis. And most importantly, encouraging kids with type 1 diabetes to enjoy each other through support groups and enjoyable activities for the whole family!

Do you find it challenging to encourage a balance with all the restrictions we suggest to our patients? That patients, well meaning neighbors and conscientious colleagues have lost the focus on the big picture? How do you respond?


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  1. Feb 14, 2011

    So, kids with diabetes can't have pizza now? Ridiculous! I have had sessions with parents and kids, new to carbohydrate counting, where I learned that the parents had one kind of cereal for their diabetic kid, one kind for the rest of the family. Learning that their child could have some sugary cereal, as long as they counted the carbs and matched their insulin doses. This quite literally rocked their world!
  2. Feb 14, 2011

    I totally agree with your response. I stress balance and moderation (emotional and nutritional) to type 1 and type 2 patients alike. I am constantly challenged to overcome misinformation that my patients receive from family, friends, the media, and other health care providers. Examples of such misinformation include: there are "good" foods and "bad" foods, carbs are bad, you should never eat foods that are white (my personal favorite - thanks, Dr. Oz), sugar is bad, sugar-substitutes are bad, etc., etc., etc. I think that the "big picture" in nutrition, health and diabetes management has certainly been lost. There is a tremendous negative influence by the popular diet / nutrition industry. I don't know what the answer is. Education of HCP's on the role of RD's and CDE's would be a great place to start.

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